Joseph R. Anticaglia MD
Medical Advisory Board
When was the last time, first time or have you ever had a discussion about erectile dysfunction? ED or impotence strikes hard at a man’s self-esteem and the symbolic association it has with power and virility. It’s a taboo subject, even more than the discussion of religion or politics in mixed company.
ED is the “persistent inability to achieve and maintain penile erection sufficient for satisfactory sexual performance.” It’s a common condition that very seldom comes out of the closet. Yet, a mind-boggling 52% of men between the ages of 40-70 have some form of ED, whether it’s mild, moderate or severe. This has been a source of anxiety for men since the beginning of time.
Brief History of ED
According to Dr. Mohit Khera, millennia ago men ate testes in an attempt to straighten out this problem. Around1500, the concept that ED was a vascular disease was proposed, blood had to “stay in the penis” to get and maintain an erection. A few hundred years later, it was reported that penile tissue needed a nerve signal to get things going. In the twentieth century, the hormone testosterone was identified Low levels of testosterone have been associated with ED, but is not the definitive cause of this problem.
In 1973 penile prosthesis was suggested as a cure for impotence. In1998 Viagra was approved by the FDA and a flood of prescriptions inundated pharmacists across America.
What a bonanza for Pfizer which sold over a billion dollars of the drug in its first year. In 2003, Cialis and Levitra were introduced and Pfizer’s five year monopoly as the sole FDA approved drug for sexual dysfunction, Viagra, ended. Stendra in the year 2012 was approved by the FDA for ED. Other treatments have also been introduced for this problem and more men are trying to rise to the occasion with their help.
The ED, CVD and the Metabolic Connection
There are physical and psychological causes of erectile dysfunction acting alone or in combination that can affect a man’s self-confidence and/or create relationship problems. From a physical standpoint, the key seems to be the connection of ED, CVD (Cardiovascular Disease) and Metabolic Health.
To maintain a healthy metabolic state and healthy lifestyle we need to:
- exercise
- eat healthy foods
- not be overweight
- enjoy a healthy relationship
- avoid stress and
- get a good night’s sleep.
In the 1970’s and 80’s Nathan Pritikin, a layman, advocated that diet and exercise could reverse heart disease. The medical establishment was skeptical, critical and antagonistic toward him and his ideas. His Pritikin Diet did reverse CVD and saved many lives. He has been quoted as saying,
“All I’m trying to do is to wipe out heart disease, diabetes, hypertension and obesity with diet and exercise.”
Presently, more physicians are thinking of ED first as a progressive disease; the way cardiologists think of CVD emphasizing initial treatment with diet, exercise and weight control. Of course, they incorporate other useful treatments for these patients
Of note is that some men, when they first experienced ED, years later had complaints of cardiovascular disease, heart attacks and diabetes. Could ED be an early warning signal for CVD and Metabolic Syndrome?
Metabolic syndrome (MeS) is the result of a combination of the unhealthy lifestyle choices (opposite of healthy lifestyle choices noted above). It’s not a disease. This syndrome puts you at a greater risk to become overweight, to develop cardiovascular disease, type 2 diabetes and stroke.
Because of the combination of habitual unwise health choices, one is more likely to have high cholesterol, high blood sugar, high blood pressure and a bulging waistline. Our metabolism and health suffer.
Three Important Tests for ED
Lipid Profile
Lipid profile or lipid panel is a group of screening blood tests used to evaluate lipids, fats in the blood, such as cholesterol and triglycerides. It evaluates your risk to develop CVD (cardiovascular disease) and used to monitor your response to treatment
Testosterone Level
Testosterone is a sex hormone, an androgen, produced by men and women. A blood test is used to measure the level of testosterone in the body and it can be low in patients with ED.
Hemoglobin A1C
A1C is a blood test measures the average blood sugar level for the previous two to three months. It measures your risk for prediabetes, to develop type 2 diabetes and evaluates how well you’re managing your diabetes.
One challenge is that 75% of men don’t receive treatment for ED. They may have feelings of shame or concerned that their physician will not have the time or mindset to take their sexual problem seriously. It’s useful that both partners participate in the treatment program.
References
Mohit Khera; Advances in the Treatment of Erectile Dysfunction; Perspectives in Urology; November13, 2015
Drogo, K. et al; AUA Practice Guidelines, The Management of Erectile Dysfunction; 2005
Johns Hopkins; What is Erectile Dysfunction(ED)?
Anticaglia, Joseph R.; Metabolic Syndrome and Wellness — Stay Off the Farm; HC Smart, 2016
GLOSSARY
Sildenafil Brand name Viagra
Tadalafil Brand name Cialis
Vardenafil Brand name Levitra
Avanafil Brand name of Stendra
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.